Healthcare Provider Details

I. General information

NPI: 1417654104
Provider Name (Legal Business Name): RIVER WALK CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2023
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W MORTON AVE
PORTERVILLE CA
93257-1947
US

IV. Provider business mailing address

1000 AVIARA DR STE 205
CARLSBAD CA
92011-4218
US

V. Phone/Fax

Practice location:
  • Phone: 559-782-1509
  • Fax:
Mailing address:
  • Phone: 760-652-6354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: AARON CHESLEY
Title or Position: MANAGER
Credential:
Phone: 559-782-1509